Background
Methods
Patient population
Study definitions
Kidney biopsy
Statistical analyses
Results
Clinical and laboratory characteristics
Patient | Sex | Age at kidney biopsy (yr) | Age at CD diagnosis (yr) | Renal pathology | CD treatment | Renal treatment | Outcome of CD | Outcome of proteinuria | Outcome of hematuria |
---|---|---|---|---|---|---|---|---|---|
1 | M | 45 | 43 | IgA nephropathy | Thalidomide | RAS inhibitors, steroids intravenously | Remission | CR | CR |
2 | M | 37 | 36 | IgA nephropathy | Thalidomide | - | ND | ND | ND |
3 | F | 17 | 15 | IgA nephropathy | Methylprednisolone tablets, methotrexate | - | Remission | CR | PR |
4 | M | 36 | 22 | IgA nephropathy | Infliximab, azathioprine | - | Remission | CR | R |
5 | M | 31 | 21 | IgA nephropathy | Azathioprine, enteral nutrition | - | Remission | CR | CR |
6 | F | 28 | 27 | IgA nephropathy | Infliximab | Pozzi regimen | ND | ND | ND |
7 | F | 16 | 18 | Minimal change disease | Methylprednisolone tablets and azathioprine | Steroids intravenously | Remission | CR | CR |
8 | M | 34 | 26 | Minimal change disease | Enteral nutrition | RAS inhibitors | Response | CR | PR |
9 | F | 19 | 18 | Thin-basement-membrane nephropathy | Infliximab, azathioprine | - | Remission | CR | PR |
10 | F | 38 | 37 | IgA nephropathy | Thalidomide, enteral nutrition | - | Remission | CR | R |
11 | F | 52 | 51 | Acute interstitial nephritis | Thalidomide | Steroids intravenously | Remission | CR | CR |
12 | M | 23 | 22 | non-IgA mesangial proliferative nephritis | Infliximab, azathioprine | - | Response | CR | R |
13 | F | 25 | 24 | IgA nephropathy | Infliximab | Pozzi regimen | Remission | CR | CR |
14 | M | 68 | 55 | IgA nephropathy | Enteral nutrition | Prednisone acetate tablets, mycophenolate mofetil | Remission | R | PR |
15 | M | 34 | 32 | IgA nephropathy | Thalidomide | RAS inhibitors | Relapse | CR | CR |
16 | M | 20 | 17 | IgA nephropathy | Infliximab, azathioprine | Pozzi regimen | Remission | R | PR |
17 | F | 65 | 42 | Granulomatous interstitial nephritis | Infliximab | Prednisone acetate tablets | Remission | CR | CR |
18 | F | 31 | 24 | IgA nephropathy | Mesalamine, azathioprine | RAS inhibitors | ND | ND | ND |
19 | M | 24 | 19 | IgA nephropathy | Infliximab, azathioprine | RAS inhibitors | Remission | CR | PR |
20 | M | 27 | 25 | IgA nephropathy | Infliximab, azathioprine | - | Remission | CR | CR |
Characteristic | Data |
---|---|
Patients — no | 20 |
Male sex — no. (%) | 11 (55%) |
Age at kidney biopsy — yr | 33.50±14.56 |
Age distribution at kidney biopsy (yr) — no. (%) | |
< 20 | 3 (15%) |
20–30 | 6 (30%) |
30–40 | 7 (35%) |
40–50 | 1 (5%) |
50–60 | 1 (5%) |
≥ 60 | 2 (10%) |
Body mass index — Kg/m2 | 19.93±2.84 |
Systolic blood pressure — mmHg | 110.60±13.17 |
Diastolic blood pressure — mmHg | 71.50±7.16 |
Serum albumin — g per L | 37.32±6.65 |
Serum creatinine — umol per L | 115.589±113.71 |
Blood urea nitrogen — mmol per L | 6.38±4.40 |
eGFRa — ml per min per 1.73m2 | 99.77±44.30 |
eGFRa category — no. (%) | |
≥ 90 ml per min per 1.73m2 | 14 (70%) |
60–89.9 ml per min per 1.73m2 | 3 (15%) |
< 60 ml per min per 1.73m2 | 3 (15%) |
Urine PH | 6.28±0.82 |
Urinary protein excretion — g per 24 h | 0.84±1.25 |
Degree of proteinuria (g per 24 h) — no. (%) | |
≤ 0.2 | 7 (35%) |
> 0.2 to < 2.0 | 10 (50%) |
≥ 2.0 to < 3.5 | 1 (5%) |
≥ 3.5 to < 5.0 | 2 (10%) |
≥ 5.0 to 10.0 | 0 (0%) |
≥ 10.0 | 0 (0%) |
Hematuria — no. (%) | 17 (85%) |
Nephrolithiasis — no. (%) | 2 (10%) |
Indication for kidney biopsy — no. (%) | |
Nephrotic-range proteinuria | 2 (10%) |
Subnephrotic proteinuria | 6 (30%) |
Persistent hematuria and proteinuria | 5 (25%) |
Isolated hematuria with acanthocytes | 5 (25%) |
Impaired kidney function (serum creatinine > 1.5 mg/dl) | 2 (10%) |
RAS inhibitors — no. (%) | 5 (25%) |
Steroids to treat renal disease — no. (%) | 7 (35%) |
Steroids intravenously — no. (%) | 6 (30%) |
Steroids combined with immunosuppressive agents to treat renal disease — no. (%) | 1 (5%) |
Clinical characteristic | Data |
---|---|
Montreal classification — no. (%) | |
Age at CD diagnosis (A) | |
A1 (Not more than 16 years) | 1 (5%) |
A2 (More than17 years but no more than 40 years) | 15 (75%) |
A3 (More than 40 years) | 4 (20%) |
Location (L) | |
L1 (Ileal) | 1 (5%) |
L2 (Colonic) | 0 (0%) |
L3 (Ileocolonic) | 19 (95%) |
L4 (Upper gastrointestinal) | 11 (55%) |
Behavior (B) | |
B1 (Non-stricturing and non-penetrating) | 12 (60%) |
B2 (Stricturing) | 0 (0%) |
B3 (Penetrating) | 8 (40%) |
P (Perianal disease) | 14 (70%) |
Age at CD diagnosis — yr | 28.70±11.63 |
Duration of CDa — mth | 84.00±77.81 |
CDAIb | 244.05±130.76 |
Active CDc — no. (%) | 13 (65%) |
Erythrocyte sedimentation rate — mm per hr | 46.70±39.59 |
C-reactive protein — mg per L | 18.85±24.41 |
CD-related gastrointestinal surgery — no. (%) | 7 (35%) |
CD treatment — no. (%) | |
5-aminosalicylic acid | 1 (5%) |
Glucocorticoids | 2 (10%) |
Biological agents | 9 (45%) |
Immunosuppressive agents | 15 (75%) |
Antibioticsd | 0 (0%) |
Enteral nutrition | 4 (20%) |
Kidney biopsy findings
Six-month follow-up | Twelve-month follow-up | ||||
---|---|---|---|---|---|
Diagnosis | Patients (n/N) | Outcome of proteinuria | Outcome of hematuria | Outcome of proteinuria | Outcome of hematuria |
IgA nephropathy | 14/20 | 10 (CRb), 2 (PRc), and two missing data | 3 (CRb), 4 (PRc), 5 (Rd), and two missing data | 9 (CRb), 2 (Rd), and three missing data | 5 (CRb), 4 (PRc), 2 (Rd), and three missing data |
Minimal change disease | 2/20 | 2 (CRb) | 1 (CRb) and 1 (Rd) | 2 (CRb) | 1 (CRb) and 1 (PRc) |
Acute interstitial nephritis | 1/20 | 1 (CRb) | 1 (CRb) | 1 (CRb) | 1 (CRb) |
Granulomatous interstitial nephritis | 1/20 | 1 (CRb) | 1 (CRb) | 1 (CRb) | 1 (CRb) |
non-IgA mesangial proliferative nephritis | 1/20 | 1 (CRb) | 1 (Rd) | 1 (CRb) | 1 (Rd) |
Thin-basement-membrane nephropathy | 1/20 | 1 (CRb) | 1 (Rd) | 1 (CRb) | 1 (PRc) |
Post-treatment condition
Six-month follow-upa | Twelve-month follow-upa | ||||||
---|---|---|---|---|---|---|---|
Diagnosis | Patients (n/N) | Remissionb | Responsec | Relapsed | Remissionb | Responsec | Relapsed |
IgA nephropathy | 14/20 | 9 | 2 | 1 | 10 | 0 | 1 |
Minimal change disease | 2/20 | 2 | 0 | 0 | 1 | 1 | 0 |
Acute interstitial nephritis | 1/20 | 1 | 0 | 0 | 1 | 0 | 0 |
Granulomatous interstitial nephritis | 1/20 | 1 | 0 | 0 | 1 | 0 | 0 |
non-IgA mesangial proliferative nephritis | 1/20 | 0 | 0 | 1 | 0 | 1 | 0 |
Thin-basement-membrane nephropathy | 1/20 | 1 | 0 | 0 | 1 | 0 | 0 |
Discussion
Characteristic | Patients (n/N) |
---|---|
Lee classification of IgA nephropathy | |
Grade I | 1/14 |
Grade II | 6/14 |
Grade III | 6/14 |
Grade IV | 1/14 |
Oxford typing of IgA nephropathy | |
M (Glomerular mesangial hyperplasia) | 11/14 |
E (Capillary hyperplasia) | 1/14 |
S (Segmental glomerulosclerosis) | 3/14 |
T (Tubular atrophy or interstitial fibrosis) | 0/14 |
C (Crescent) | 2/14 |
C0 | 0/14 |
C1 | 2/14 |
C2 | 0/14 |
Immunofluorescence | |
IgG | 0/14 |
IgA | 14/14 |
IgM | 11/14 |
C3 | 10/14 |
C1q | 0/14 |
Fibrinogen | 0/10a |
Kappa | 4/10a |
Lambda | 5/10a |
IgG1 | 0/11b |
IgG2 | 0/11b |
IgG3 | 0/11b |
IgG4 | 0/11b |
PLA2R | 0/11b |